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Editorial Supportive Care Oncological Scenario in Developing Countries – Little Light at the End of Tunnel Lt Col Virender Suhag, Lt Col Sunita BS and Lt Col Manu Chopra Army Hospital (R&R), Delhi, India O ver the past few decades, the incidence and prevalence of most cancers has witnessed a consistent upward trend in majority of developing countries due to various reasons. Unfortunately, most of these countries continue to battle lots of challenges in cancer care, including poverty, illiteracy, lack of awareness, lack of dedicated oncology centers, non-existent hospice care, administrative hurdles, shortage of skilled manpower and indifferent attitude of most governments. These countries need the support of developed countries in various forms in their fight against cancer. Time has come when we need to push ourselves out of our comfort zones to evolve a multipronged realistic approach to decrease the suffering from cancer and to make this world a happy healthy place. Keywords Advanced cancer, developing countries, high mortality & morbidity, lack of facilities, palliative care, united efforts Disclosure: Virender Suhag, Sunita BS and Manu Chopra have nothing to disclose in relation to this article. No funding has been received for the publication of this article. This article is a short opinion piece and has not been submitted to external peer reviewers. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 13 February 2017 The incidence and prevalence of most cancers is increasing worldwide because of the aging population, increased prevalence of established risk factors with urbanisation and economic development and changing social and demographic trends including late marriage and fewer child-births. Based on GLOBOCAN and International Agency for Research on Cancer (IARC) estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide, this figure is expected to grow to 21.7 million new cancer cases and 13 million cancer deaths by 2030. 1 Globally, the cancer burden is gradually shifting to developing and under-developed world, which currently account for about 57% of new cases and 65% of cancer deaths worldwide. 1,2 However, the oncology scenario in most developing countries is still dismal, plagued by lack of screening, delayed diagnosis, long travel time to cancer hospital, shortage of cancer centres, poor infrastructure, outdated technology, manpower crunches, long waiting lists, lack of accommodation for outstation patients, lack of affordability and apathy of government agencies. With regard to India, from an estimated incidence of 1.45 million cases in 2016, the cancer incidence is expected to reach 1.75 million cases in 2020. 3 It is estimated that about 70–80% of these cancers present are at stage III and IV resulting in high mortality rate. An estimated 600,000–700,000 deaths in India were caused by cancer in 2012. 4,5 Published Online: 31 March 2017 Citation: European Oncology & Haematology, 2017;13(1):13–4 Corresponding Author: Virender Suhag, Dept of Radiation Oncology, Army Hospital (R&R), Delhi, India. E: Most of the government hospitals and medical colleges in these developing countries are battling with outdated poorly-maintained radiotherapy machines which require immediate replacement. Most of these countries have one machine for several million people with huge deficiency of trained manpower, and telecobalt units continue to be the main workhorse rather than the linear accelerators. 6 Such heavy workload compromises the quality assurance and preventive maintenance of these machines. Though economy in few developing countries is trending upwards, the governments are hardly spending anything on healthcare. The expenditure on healthcare in India in 2015 and 2016 by the centre and state governments was 1.3% of the GDP (Anupriya Patel, Minister of State for Health and Family Welfare, statement to Media). Moreover, the process of up-gradation and modernisation in public sector is long, tedious and complicated by unhealthy competition between the limited number of vendors and corruption in various procuring agencies. There is urgent need to develop affordable, low-maintenance, indigenous machines best suited to Indian requirements. Some progress has already been made in this regard, though there is still tremendous scope of improvement and various public labs, apex medical research institutes and other government agencies involved in research and development should join hands to make more medical linear accelerators and install them in smaller cities. 7 There is great diversity between the oncology facilities available to different strata of society. The privileged ones from affluent class, which constitute a minor part of overall population, have access to the newly commissioned multi-specialty corporate hospitals in urban metropolitan cities. These centres are equipped with state-of-art imaging tools and linear accelerators compatible with highly conformal radiotherapy. However, the majority of patients from lower and middle socio-economic strata do not have access to such facilities due to poor affordability, as most of the medical linear accelerators are imported and treatment is quite costly. These patients are treated in peripheral centres in public setup, most of which are ill-equipped with TOU CH MED ICA L MEDIA 13